Herpes, Genital
Basics
Description
- Chronic, recurrent herpes simplex virus (HSV) type 1 or 2 infection of any area innervated by the sacral ganglia
- HSV-1 causes anogenital and orolabial lesions; HSV-2 causes anogenital lesions.
- Primary episode: occurs in the absence of preexisting antibodies to HSV-1 or HSV-2 (may be asymptomatic)
- First episode, nonprimary: initial genital eruption; preexisting antibodies are present.
- Reactivation: recurrent episodes
- Synonym(s): herpes genitalis
Epidemiology
- Most commonly infected from age 15 to 30 years; prevalence increases with age due to cumulative likelihood of exposure.
- Predominant sex: female > male
- Predominant race: non-Hispanic blacks
Incidence
True incidence is unknown because genital herpes is not reportable. Studies estimate the incidence in the United States to be ~572,000 to 1.6 million new cases per year; highest in 18- to 24-year-olds.
Prevalence
- Overall prevalence of HSV-2 is 10–40% in the general population and up to 60–95% in the HIV-positive population (1).
- Between the ages of 14 and 49 years, the prevalence of HSV-1 in the United States is ~48%, and the prevalence of HSV-2 is ~12%.
- Up to 90% of those who are seropositive lack formal diagnosis.
- Globally, it is estimated that HSV-1 infects 3.7 billion people versus 140 million for HSV-2.
Etiology and Pathophysiology
- HSV is a double-stranded DNA virus of the Herpetoviridae family (1).
- Spread via genital-to-genital contact, oral-to-genital contact, and via maternal–fetal transmission (2)
- Incubation is 4 to 7 days after exposure.
- Risk of transmission is highest when lesions are present.
- Viral shedding is possible in the absence of lesions, increasing the risk of transmission (precautions—abstinence, condom use—may not be followed). Viral shedding occurs intermittently, unpredictably, and more commonly with HSV-2.
- HSV infection increases the risk for HIV.
Risk Factors
- Risk increases with age, number of lifetime partners, history of sexually transmitted infections (STIs—particularly HIV), sexual encounters before the age of 17 years, and partner with HSV-1 or HSV-2.
- Infection with HSV-1 confers 3-fold risk of infection with HSV-2.
- Immunosuppression, fever, stress, and trauma increase risk of reactivation.
General Prevention
- Use barrier contraception and avoid sexual contact when symptoms/lesions are present.
- Abstinence is the only means of complete protection.
Commonly Associated Conditions
Syphilis, HIV/AIDS, chlamydia, gonorrhea, other STIs
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Citation
Domino, Frank J., et al., editors. "Herpes, Genital." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688790/all/Herpes__Genital.
Herpes, Genital. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688790/all/Herpes__Genital. Accessed October 11, 2024.
Herpes, Genital. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688790/all/Herpes__Genital
Herpes, Genital [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 11]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688790/all/Herpes__Genital.
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